Mental health - see the person, not the problem
From an article in The Plough
John Swinton is a Scottish theologian whose work explores disability, mental health, and discipleship. He is a minister in the Church of Scotland. Before his academic career, he was a mental health nurse. He holds the chair of divinity and religious studies at the University of Aberdeen. He was interviewed about Christian approaches to mental health challenges following the publication of his fourth book on mental health, Finding Jesus in the Storm. Here are some extracts from the interview:
My background is in mental health nursing, where I worked for many years before retraining as a nurse for people with intellectual disabilities. So mental health has always been an important aspect of my life. I did my PhD thesis on the relationship between schizophrenia and Christian friendship. The key theme in that work was Christian friendship, or more accurately the friendships of Jesus. The principle of the incarnation is that God, who is radically unlike human beings, becomes a human and offers humans friendship. But that friendship is not based on cultural norms that assume friendships are like-attracted-to-like. It is based on the principle of Grace: we become friends just because that is what Christians do. Friendship helps rehumanize people whom society dehumanizes.
One of the challenges of living within a highly medicalized society is that it is almost impossible to think of illness without first thinking of medicine, despite the fact that most healing goes on in community via friendships, family, colleagues and so forth. We implicitly or explicitly have a bias towards a model of health that is gauged by the absence of illness and/or the control of symptoms: we are considered well when we have no symptoms and no distress. But for those living with enduring mental health challenges, this means they are always ill! If you and others consider yourself always to be ill, that inevitably limits your expectations.
Jesus says that he comes to bring life in all of its fullness (John 10:10). The life of Jesus and indeed of many of his followers down through the centuries would indicate that fullness of life does not mean life without suffering, or life without illness. Life in all its fullness comes to us when we learn what it means to be with Jesus in good times and in bad. It is as we journey through the complexities of life with Jesus that we discover fullness of life.
The metaphor of a journey helps us see this. A journey always has a direction and an intention. It is moving somewhere rather than nowhere. We journey through beautiful fields and lush pastures as well as steep mountain valleys and across barren ground. But even in the difficult times there is forward movement; there is hope. To be considered always ill, to be told “if you take your medicine your symptoms will be controlled but that is the best that we can offer,” is to turn the journey into a waiting room.
One of the main international manuals for diagnosing physical and mental disorder is the International Classification of Diseases (ICD). Reviewers with mental health challenges observed how negative the diagnostic criteria were, that they seemed to focus purely on the negative experiences of mental health issues and not on any possible positives. For example, people with bipolar disorder were concerned that its creative dimensions were not acknowledged. Many great painters and musicians have had bipolar disorder and their creativity has been enhanced by these experiences.
Psychiatry exists to deal with problems, so it’s not surprising that the basic criteria for describing mental health challenges tend to be problem-focused. This is not a criticism of psychiatry – problems need to be dealt with. It is, however, a significant limitation on the amount of information one can gain from a diagnostic manual. We will become more humane about describing mental health issues by listening carefully to the whole of people’s stories, not just of their illnesses, but their whole lives and how mental health challenges fit into and impact them. When we listen, and if we are willing to hear, surprising things can come to the foreground.
In his book on discipleship, Dietrich Bonhoeffer has a section on Matthew’s call. He points out that when Matthew first encountered Jesus, he didn’t know who he was: Jesus called and Matthew followed. Bonhoeffer points out that his calling was not based on what Matthew knew about Jesus. It is true that one can presume that he knew who Jesus was, that he had heard the stories and that he had made an informed choice to follow Jesus; the Bible does not say that. In order to think that you need to move beyond the text.
What this teaches us about discipleship is that it is not knowing things about God that matters; it is following Jesus that is its essence. Following Jesus is not an escape from the world or a matter of accumulating knowledge about God. It is a way of being in the world, where even in the wildest of storms, you learn to trust that Jesus is with us and for us in all things and at all times. True, sometimes it doesn’t feel that way. When someone is in the depth of depression it is sometimes difficult to feel the presence of God. But Jesus had the same experience on the cross: “My God, my God why have you forsaken me?” (Matt. 27:46). Following Jesus does not mean escaping from problems, difficulties, pain, and suffering. It means finding the possibility of hope in all of these experiences and learning to live lives which are marked by the desire for God’s presence even when sometimes that presence is elusive. I think that is one of the many things that I have learned from listening to Christians living with mental health challenges.
And this changes our approach to mental health in the church. Sometimes when we think about mental health issues, we focus on pastoral care or/and ethics. Nothing wrong with that! All of us need to be cared for, and ethical issues are basic to the Christian life. However, I think mental health is best located within Christian life in a different way. I think the key question is: How can we (the Body of Jesus), enable this person who is a disciple of Jesus, who is going through difficult times, to find and hold on to their vocation even in the midst of the storms?
One thing the pandemic has taught us is that we are all, across the globe, interconnected and dependent on one another. Previously we may have thought that we were discrete individuals only responsible for ourselves and those close to us. We have learned that we are persons-in-relation at a personal and community level. We have also learned that many people within our societies are lonely and disconnected. All of us need love and connection.
Even when we feel lost, helpless, uncertain about the future and unable to work out where life is going, we can still feel, see, and experience love. More than that, the presence of such love can drive out fear. The experience of mental health challenges at times can be quite frightening. We need people who will love us out of our fear and help us to find love amidst the challenges. If we know we are loved, we need not be fearful. In times of mental health challenge, as in all times, we need people who will act gently, patiently, kindly, humbly, respectfully, peacefully. We need people whose lives are filled with forgiveness, honesty, and integrity (1 Cor. 13). We need to be reminded of the presence of the God who is love. We need people whose faces are a picture of love.
Learning to become such people is the way forward.
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From an article in The Plough, 08/06/2022